Provider Demographics
NPI:1275570723
Name:STASHCHYSHYN, VLADIMIR (MSPT)
Entity Type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:
Last Name:STASHCHYSHYN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RIDGEDALE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1106
Mailing Address - Country:US
Mailing Address - Phone:973-449-1394
Mailing Address - Fax:973-270-0684
Practice Address - Street 1:14 RIDGEDALE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927
Practice Address - Country:US
Practice Address - Phone:973-449-1394
Practice Address - Fax:973-270-0684
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01004600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081807MYEMedicare ID - Type Unspecified